Healthcare Provider Details

I. General information

NPI: 1073907903
Provider Name (Legal Business Name): KELLY ROSE CAMPBELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY ROSE CAMPBELL HEDMAN

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-9128
  • Fax:
Mailing address:
  • Phone: 808-433-8160
  • Fax: 808-433-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19633
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH029149
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: